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The woes of the womb

One in 20 pregnant women in India develop gestational diabetes, or an inability to control blood sugar levels during pregnancy.

kolkata Updated: Jan 29, 2010 00:30 IST
Sandip Chowdhury

One in 20 pregnant women in India develop gestational diabetes, or an inability to control blood sugar levels during pregnancy.

With an estimated 40 million people in India with diabetes, a condition where the body does not produce enough insulin to regulate blood sugar, experts say the number of pregnant women affected with it is likely to go up.

“Though gestational diabetes disappears after the baby is born, it indicates that the mother’s ability to make insulin is impaired. Globally, studies show that 50 per cent women with gestational diabetes become diabetic within a decade... Indian women with gestational diabetes are likely to develop diabetes in a shorter period,” said Dr Anoop Misra, director, department of diabetes and metabolic diseases, Fortis Hospitals, Delhi.

“The number of cases across the metros are definitely increasing every year but that’s also because reporting has improved. Doctors now routinely recommend blood glucose tests for all pregnant women,” said Dr HB Chandalia, consultant diabetologist, Lilavati and Jaslok Hospitals.

Kolkata shows similar increase, with Dr Ranjit Chakraborti, a gynaecologist at Woodlands Nursing Home, blaming “western lifestyle” for the rising numbers. “Of late, Kolkata has caught up with western lifestyle and increased the numbers of high-risk pregnancy, which is common in women who are obese, have sedentary jobs or have their first child after the age of 30,” said Dr Chakraborti.

“Almost 5-10 per cent pregnant women have gestational diabetes in Kolkata, whereas the national average is around 4 per cent,” he said.

Large teaching hospitals in Kolkata, however, show the city data are similar to the rest of the country. “In our hospital, around 5 per cent women have gestational diabetes, but we cannot share patient details as the information is confidential,” said Dr Tarun Kumar Ghosh, head of the department of gynaecology, Institute of Post Graduate Medical Education and Research and SSKM Hospital.

There is risk to the health of a baby of a woman with gestational diabetes from birth itself, with her/his large size increasing the baby’s chances of suffering injuries such as bone fracture during delivery. Big babies are often delivered surgically through C-sections.

Also, the high glucose in the mother’s blood crosses over to the baby and forces its tiny pancreas to produce extra insulin in the womb. After birth, the pancreas may not be able switch off production and continue to produce too much insulin, which can affect neurological development.

“Large babies are also likely to grow up to be obese and to have diabetes themselves, but the good news is that by treating gestational diabetes during pregnancy, all these risks can be removed,” said Dr Anoop Misra.

Doctors said diet and long walks are the ideal treatment for gestational diabetes. But if the glucose levels do not drop, the patient may be prescribed small doses of insulin daily.

A study in the New England Journal of Medicine last year recommended treating the baby and the mother, but it is easier said than done. No one still knows when exactly a mother’s high blood sugar level begins to affect the developing foetus and whether mild cases should be treated at all.

“Oral medication is not recommended during pregnancy, but controlling blood glucose is important as gestational diabetes causes complications at birth and also pose a health threat to the newborn,” said Dr Tapan Kumar Mukherjee, a Kolkata-based primary care physician.

Prevention is the safest and most effective option, says Dr Suneeta Mittal, head of the department of gynaecology, All India Institute of Medical Sciences (AIIMS). “Women should get their blood sugar tested before even trying to get pregnant and if it high, get it treated and brought under control. High blood sugar at conception and in the first trimester (3-month) is strongly associated with multiple birth defects and miscarriage and stillbirths,” she said. The best test to get is the glycosylated hemoglobin (HbA1c test), which measures your average blood sugar over the space of three months.

“When a pregnant woman has high blood glucose level, doctors assume it is gestational diabetes. It can also be Type 2 diabetes, a condition we call pre-gestational diabetes,” said Dr Chandalia.

(With inputs from the Delhi and Mumbai health bureaus)